MEDICARE: DR. JEROME ADAMS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TF0000X	Family Psychologist	439	RI

General Provider Information

NPI Number	:	1699846832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME ADAMS PH.D.

Provider Business Mailing Address
First Line	:	115 ROBINSON ST
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-3509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 PHILLIPS ST
Second Line	:	SUITE 201
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-5149
Country	:	US
Telephone Number	:	401-295-1590
Fax Number	:	401-295-1230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	07/08/2007

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